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The New Jersey Department of Banking and Insurance (‘DOBI’) has published statistics tracking the number of Surprise Bill cases submitted to Maximus Federal, the DOBI contractor handling arbitration cases under the New Jersey Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act.  Since the Act went into effect August 30, 2018, Maximus has received 5,715 […]

The deep divide between insurers and providers over the best approach to end the practice of surprise billing patients appears to be narrowing, according to coverage by Politico published on Friday as new legislation is expected to be part of the year-end funding package. The latest proposal, ‘calls for parties to negotiate an agreed-upon rate […]

Last week the White House issued an Executive Order that addressed, in part, healthcare cost transparency and surprise billing.  The Administration urged Congress to act on legislation to end the practice of balance billing by December 31, 2020 and directed the Secretary of Health and Human Services, Alex Azar, to provide more public information on […]

During these unprecedented times, many elective surgeries have been suspended to allow for COVID-19 patients to receive necessary care in their time of need. This has halted most plastic surgeries for the time being, but plastic surgeons are not taking this time for a staycation, instead they are hard at work helping their colleagues and […]

President Trump called upon Democrats and Republicans to pass legislation to end surprise medical billing in remarks delivered from the White House earlier this month.  Senators from both sides of the aisle have already been working on legislation for months to ban surprise medical bills. Surprise billing occurs when an out-of-network provider bills a patient for […]

Yesterday, NJ legislators passed Bill S-3202, sponsored by Senator Lagana and Senator Gopal, in a unanimous vote.  The bill requires hospitals to provide breast cancer patients with information concerning reconstructive surgery.  It also prohibits carriers from preventing the referral of a patient to an out-of-network surgeon who provides “the full scope of breast cancer reconstructive […]

Yesterday, a letter signed by America’s Health Insurance Plans (AHIP) and others asks Congress to take action this year to “pass legislation that will protect patients from surprise medical bills and reign in out-of-control health care cost.”  The letter outlines several steps to protect patients, most notably, requiring any legislation to encompass all health plans, […]

Today, Kaiser Health News published an insightful article on the Federal Surprise Bills being considered.  Federal legislation is likely to significantly expand patient protection, in states that already have surprise bills enacted, by including self-funded plans under ERISA and will provide much needed protection in states where surprise bills have yet to be enacted.  Details […]

On January 22, 2019 the NJ Bill S-3203, sponsored by Senator Joseph Lagana and Senator Vin Gopal, requiring hospitals to provide breast cancer patients with information concerning reconstructive surgery was released from committee and will head to the full Senate for further consideration.  Additionally, the legislation will not limit a health care provider in making […]

As part of the agreement, EmblemHealth will provide full restitution to members who paid out-of-pocket for gender reassignment surgical procedures after denial of coverage by EmblemHealth.  For the full article please click here.

Law360 (December 11, 2018, 10:09 PM EST) has published an article covering another case in which Cohen Howard has successfully challenged the under-reimbursement of authorized medical services rendered by our client, an out-of-network provider.  For the full article please click Law 360 Article on Linares Decision. For the complete Opinion issued by Chief District Judge […]

On November 20, 2018, The New Jersey Department of Banking and Insurance (“DOBI”) released Bulletin No. 18-14 (the “Bulletin”) relating to Implementation of P.L. 2018 C. 32 (N.J.S.A. 26:2SS-1 to -20) Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Surprise Bill Act”).  As a reminder, the Surprise Bill Law relates to ER and […]